

			 THE WHITE HOUSE

		  Office of the Press Secretary
		     (Minneapolis, Minnesota)
_________________________________________________________________
For Immediate Release                               April 8, 1994

	     
		     REMARKS BY THE PRESIDENT
	   AT "HEALTH CARE IN THE HEARTLAND" TOWN HALL
	     
	     
			     KSTP-TV
		      Minneapolis, Minnesota
	     
	     

7: P.M. CDT
	     
	     
	     MS. ASTORE:  Welcome to the Twin Cities and our town 
hall meeting.  And thank you for this unique opportunity to 
answer questions about your health care program.
	     
	     THE PRESIDENT:  Well, thank you for giving me the 
chance to do it.  And I want to thank the people who are joining 
us from Milwaukee and Detroit and Sioux Falls, too.
	     
	     MS. ASTORE:  We'd like you to start off the program 
perhaps with some opening remarks.
	     
	     THE PRESIDENT:  I'll do that.
	     
	     MR. MEIER:  We turn it over to you.
	     
	     THE PRESIDENT:  Thank you.
	     
	     First, let me say, I came here to Minneapolis late 
last night, and I started the day off with a rally for health 
care sponsored by the Nurses Association of Minnesota.  Over two 
million nurses in the Nurses Association have endorsed our health 
care plan.  And that's especially important to me because I 
started out my interest in health care because my mother was a 
nurse.  
	     
	     And then, many years ago when I started out in 
public life, I was an attorney general, and one of my jobs was to 
try to ensure good care within our nursing home system in my 
state.  Then as a governor, I had to worry about health care for 
the poor through the Medicaid program, something Minnesota and 
every other state has wrestled with.
	     
	     About four years ago, a long time before I even 
thought I'd be running for president, I agreed to take a look at 
the health care system for the nation's governors to see what we 
could do about it.  And at that time, I talked to literally 900 
health care providers -- doctors, nurses, hospital 
administrators, paramedical workers of all kinds.  And a lot of 
businesspeople and health care consumers, people in every kind of 
medical problem you can imagine.  I became convinced then that 
unless we had a national solution to a lot of our health care 
problems, we wouldn't be able to solve them; that no state, even 
the most progressive state, could solve all the problems of the 
health care system without a national solution.
	     
	     And let me just briefly say what I think the issues 
are -- and a lot of them will be represented by people who are in 
our four audiences tonight.
	     
	     First of all, 39 million Americans don't have health 
insurance at all, ever, during the year.  And about another 
100,000 a month are losing their health insurance permanently.  
Secondly, at any given time in this nation of about 260 million 
people, 58 million people won't have health insurance at sometime 
during the year.  Third -- and it gets worse as we go along here 
-- about 81 million of us live in families with so-called 
preexisting conditions -- a child with diabetes, a mother with 
cancer, a father who had a heart attack early but still had to go 
back to work.  Those families either can't get insurance, pay 
very high rates, or can never change their jobs because if they 
change jobs they won't be able to get insurance in their new 
jobs.
	     
	     Fourth, small businesspeople and self-employed 
people who have health insurance pay on the average 35 percent 
more than those of us who are insured, who are government workers 
or who work for bigger business.  And 133 million of us have 
health insurance policies with lifetime limits, which means that 
if someone in our family should get real sick, we could run out 
of our insurance just at the time we need it the most.  
	     
	     In addition to that, we're spending 40 to 50 percent 
more of our national income on health care than any other country 
in the world.  The cost of health care to state and government 
and to the federal government is exploding at two and three times 
the rate of inflation.  All the things I'd like to do for you as 
President, in terms of investing more in education and training 
and new technologies for the 21st century, are limited by how 
much we have to put into health care every year to pay more for 
the same health care.
	     
	     There are lots of other problems.  We have tens of 
millions of Americans with disabilities -- some of them are here 
-- who could work, who could be self-supporting, who get no help 
for long-term care in their homes and who can't get health 
insurance if they go to work.  We have older people on Medicare 
who need help with their medical bills and if they could get 
medicine, they could stay out of hospitals and save us money and 
have a better quality of life; but that's not covered.  So the 
question is, what are we going to do about this?  Let me very 
briefly tell you what I think we should do, then we'll open the 
floor to questions.
	     
	     First of all, I'm convinced that we can't solve any 
of our problems until we deal with the basic one.  We can no 
longer be the only advanced country in the world that doesn't 
provide health care security to all of our citizens all of the 
time.  If you want to do that, there are only two ways to do it.  
You either have to have a system where you get rid of insurance 
all together and have the government fund it, the way Canada 
does; or you have to have a system of guaranteed insurance, the 
way Germany does and several other countries.  I advocate -- and 
I'll explain why later -- I think we should have a system of 
guaranteed private insurance with comprehensive benefits 
including primary and preventive care, which saves a lot of money 
in the long run; with no lifetime limits; and insurance that you 
can't lose.  
	     
	     I believe that our system should maintain something 
that's very important to Americans, which is the choice of 
doctors and health care plans.  More and more Americans are 
insured in plans that deprive them of any choice of their 
doctors; and that can be a serious problem.  I believe there are 
ways to control costs and protect choice.  Our plan would 
guarantee you at least three choices every year.  
	     
	     Third, we have to change insurance practices.  We 
have to make it illegal for people to have their coverage dropped 
or benefits cut, for rates to be increased just because there's 
someone in the family with a preexisting condition who's been 
sick, for lifetime limits to cut off benefits, or for people who 
are older to be charged more.  This is a big deal.  The average 
person's going to change jobs eight times in a lifetime.  A lot 
of people are losing their jobs in their 50s and 60s and have to 
get new jobs and can't get jobs because no one will give them 
insurance because their rates are higher.
	     
	     Fourth, I want to preserve Medicare, which keeps the 
choice of doctors.  But I also want to have Medicare begin to 
cover prescription drugs, which it doesn't now, and phase in a 
long-term care program not only for the elderly, but for 
Americans with disabilities.
	     
	     Finally, I think these health benefits should be 
guaranteed in private insurance at work.  Why?  Because it's the 
simplest way to get to universal coverage from where we are now.  
Nine out of ten Americans with private health insurance are 
insured through the workplace.  Eight out of ten Americans who 
don't have any insurance at all are in working families.  So the 
simplest way to cover this is to say, the employed uninsured 
should have their insurance paid for by the employers and the 
employees.  The government should pay for the unemployed 
uninsured, and should raise a pool of money to provide discounts 
to small businesses who otherwise couldn't afford health 
insurance.  That's essentially our plan -- guaranteed private 
insurance, the choice of the doctor, reform insurance procedures, 
preserve Medicare, have health benefits guaranteed at work.
	     
	     One last thing -- you have to find a way if you want 
to reform the insurance practices to make it possible for 
insurance companies to do these things, which means they have to 
insure all of us in very large pools; and we have to let small 
business people and self-employed people band together in co-ops 
so they can bargain for the same good prices that those of us who 
are insured through big businesses or government get.  That's 
essentially what we're trying to do in the Congress this year.
	     
	     MS. ASTORE:  Mr. President, we're going to start 
with a couple of questions from our Twin Cities audience.  
	     
	     MR. MEIER:  Our first question comes from this 
gentleman from St. Paul.  
	     
	     Q    Welcome to Minnesota.  It's indeed an honor.  
I'd like to talk philosophically -- a philosophical basis for 
universal health coverage.  I'll go first, then I'd like to hear 
your philosophical arguments in support. 
	     
	     I've got an interest in ethics and redistribution.  
I firmly believe that the redistributionist policy undermines the 
basic sense of personal responsibility by transferring authority 
for decisions -- crucial life decisions --from the individual to 
the state.  When a do-everything government assumes control of a 
person's most personal responsibilities, we lose faith in our 
capacity to make our own decisions.  And we've seen the 
deleterious effects of dependency upon -- of dependency upon an 
institution such as --
	     
	     MR. MEIER:  Go ahead and ask your question.
	     
	     Q    Okay.  My question is, is you plan really a 
health plan or is it a power grab?  I'd like the philosophical 
arguments in support of your plan.  I do not want to hear 
compassion.  I want something more concrete.
	     
	     THE PRESIDENT:  Well, compassion is part of my 
philosophy.  But anyway, philosophically, I don't believe the 
government can solve all the problems for people; and I don't 
think you should rob people of their personal responsibilities or 
their personal choice.  That's why I don't have a government-run 
plan.  It's private insurance.  And people who don't have 
insurance have the responsibility to provide it for themselves. 
	     
	     But I believe philosophically it is wrong for people 
not to assume responsibilities for themselves and let other 
people do it.  And what's happening today -- let me just give you 
two examples.  Self-employed person x decides, well, I'm not 
going to have any insurance.  The they get in a wreck; they show 
up at the emergency room; they can't pay.  They could have had 
insurance, but they didn't do it.  That's fine for them, except 
they get the care.  Nobody let's them die; and nobody thinks they 
should; and then the rest of us pay for it.  And that is 
irresponsible.
	     
	     Another example:  restaurant x and restaurant y next 
together -- one covers the employees, the other doesn't.  One is 
fulfilling a responsibility not only to himself and the 
employees, but to the rest of society by not asking us to bear 
the risk of anybody getting sick; the other isn't.  The other has 
a competitive advantage in business.  I don't think that's right.
	     
	     And the system we have is not an individual 
responsibility system, it's an irresponsibility system.  I don't 
plan to take over the health care system.  I don't want the 
government to run it.  I think the government should help to 
organize the markets so that small business people and self-
employed people can afford to have insurance, and so that they 
are not disadvantaged as compared with big business and 
government.  And I think it is irresponsible for people not to 
provide for their own health care and irresponsible for the 
government not to make it possible for people to do it not matter 
what their station in life.

	     MS. ASTORE:  Mr. President, this woman is a school 
principal from St. Paul, and she's concerned about losing certain 
benefits.
	     
	     Q    Good evening, President Clinton.  I have been 
real concerned about the health policy.  I've followed it along 
since your beginning presidency.  I wondered about you and 
Hillary's true concerns.  I've been concerned that it might be a 
political issue with you, and I wondered how it will affect all 
Americans.  Will we really receive better service?  I wondered 
about the people who have insurance.  Will we have to pay more?  
Will we get less then?  Will we have less choice of doctors or 
less of choice of hospitals?  Will the doctors have less choice 
of the services that they can provide?  Will we have more 
government debt?  Will we have more taxes?  I'm wondering if your 
program is about controlling rather than better service.  And I 
realize that we in Minnesota are ahead of many states, but I do 
have real concerns. 
	     
	     THE PRESIDENT:  Well, let me try to answer two or 
three of those questions -- you asked me ten at once so --
(laughter.)  The only real tax we have in this plan -- we have to 
raise funds to pay for the unemployed uninsured which we're all 
paying for any way, folks.  When they get sick, they wait until 
it's too late, it's too expensive, they show up at the emergency 
room and we pay.
	     
	     Under our plan we would raise a fund to pay for them 
and to pay for the discounts on small business from two sources 
-- one, a tax on cigarettes, and the other, a modest assessment 
on the biggest American companies that will get the biggest 
windfall from this.  That is, most big companies are paying way 
too much in insurance now to subsidize the rest of us.  They'll 
get a windfall.  We ask for a portion of that back to create a 
fund for discounts for small business and for the unemployed 
uninsured.
	     
	     There will be more choice under our plan.  This idea 
that every American today has a choice of doctors is a myth.  
More than half the American people who are insured in the 
workplace today don't have a choice.  They get one plan and 
that's it.  Ninety percent of the American people who are insured 
in small businesses with 25 or fewer employees have no choice.  
Under our plan there will be more choices.
	     
	     That's one of the reason why so many medical groups 
have endorsed this plan -- not just the nurses, but the family 
practitioners, the pediatricians.  Any number of other medical 
groups have endorsed our plan because they know it guarantees 
more choice.
	     
	     Now, if you have a plan today that is better than 
the one in our bill, you can keep it.  In other words, if you 
have a plan today where your employer pays 100 percent of your 
health insurance, not 80 percent, and you continue to do that, 
that's perfectly alright.  We don't change that at all.
	     
	     Q       individual when you go for universal 
coverage.  If I already have a policy, isn't it true that it will 
cost people that now pay for insurance more?
	     
	     THE PRESIDENT:  No, if you don't pay your premium, 
if your employer pays all of your insurance now --
	     
	     Q    They don't pay all of my insurance, I carry 
family coverage.
	     
	     THE PRESIDENT:  Well, the question is whether it 
will cost you more.  It depends on a lot of factors.  In all 
probability, you won't.  All the -- not our studies, but all the 
nonpartisan studies that have been done show that more than half 
the people will get the same or better insurance for the same or 
lower cost.
	     
	     By and large, the people who will pay more are 
people who aren't paying anything now, people who have only very 
bare-bones coverage now, and young single workers will pay more 
so that older people can pay less and we can have a large 
community rating.  Otherwise, most other people will pay the same 
or less.
	     
	     But if you have a better plan than we require, what 
this does is put a floor under you.  We've got -- keep in mind -- 
I don't know where -- I mean, I understand, I saw those ads 
putting out all that propaganda, "this is just politics," "this 
is just a power play," and all that.  Tell that to these people 
who are disabled who can't get insurance.  Tell that to these old 
people who choose between medicine and food every month.  Tell 
that to the 100,000 Americans a month who lose their health 
insurance.  Tell that to the farmers and the small businesspeople 
who insure at 35 and 40 percent higher rates.
	     
	     I mean, this is a bunch of hooey.  If people don't 
agree with me, let them come forward and contest me with their 
ideas.  But I am sick, and I think a lot of you must be sick, of 
all this hot air rhetoric and all these pay television ads and 
all these hit jobs from people who are making a killing from the 
insurance business that we have today.  It is wrong and we should 
change it.  (Applause.)
	     
	     Let me just tell you something -- I don't go around 
-- I don't mind doing this; I'll do this all night.  But it never 
gets -- one of the things I've learned in 20 years of public life 
is you don't get very far questioning other people's motives.  
Most people I've met -- contrary to what you read, most of the 
people I've met in public life are honest, well-meaning.  They're 
not crooks and they're trying to do the right thing.  We have 
differences of opinion.  But this health care debate, in my 
judgment, has really been retarded -- in more ways than one --
(laughter) -- by all this motive throwing around we've had.  
	     
	     If I had wanted to take on a tough issue I could 
have found something else to do with my time.  I believe we have 
to do this.  And if we don't do it you're going to have more 
people without insurance, more people that can't afford what 
they've got, and a terrible situation in this country.  And 
that's why I did it.  That doesn't mean I'm right, but let's 
argue about what should or shouldn't be done and not talk about 
other people's motives.  I've even tried to convince the 
insurance industry I don't want to attack their motives.  I just 
want us to argue about what we should do.
	     
	     MR. MEIER:  Mr. President, I want to direct you to 
this side of the floor where you can look at that large monitor.  
I want to give our live satellite audiences a chance to join in.  
Let's go first to WDIV TV in Detroit, and Carmen Harlan.
	     
	     Q    Thank you, Randy.  They were living the 
American Dream.  The Bertolones had two healthy children, a nice 
home, and their own business.  But in a matter of months, their 
dream life changed.
	     
	     (Film is shown.)
	     
	     Three years later, Tony Bertolone lost his wife to 
cancer.  The family's last year together was spent battling the 
disease and the insurance company.
	     
	     (Film continues.)
	     
	     That's when the battle began.  Linda, Tony, and the 
organization That's What Friends Are For began a letter-writing 
campaign.  Seven weeks later, the company changed its mind.  But 
the cancer had spread.
	     
	     (Film continues.)
	     
	     And to talk more about that pressure, Tony is with 
us tonight.  We used that video tribute that Tony made in his 
story to his wife.  It is a legacy for her children and for her 
family.  And as I said, Tony Bertolone is with us in the studio 
with a question for the President.
	     
	     Good evening, and welcome.  What is your question?
	     
	     Q    My wife had advanced breast cancer.  She was 
told by a leading bone marrow transplant unit in the country that 
they had a 25 percent chance of prolonged life extension if she 
would receive the transplant.  Our insurance company deemed the 
procedure experimental and would not cover the expense.  Would 
women in a similar situation be told the same under your health 
care plan?
	     
	     THE PRESIDENT:  It's an issue I'm very familiar 
with.  As you may know, my mother had breast cancer, and so I've 
learned a lot about this issue.  What we would cover under this 
health care plan -- transplants of all kinds as long as the 
doctors thought it was an appropriate procedure.  
	     
	     Now, there are some people who still believe bone 
marrow transplants for breast cancer are experimental, although 
there's a lot of evidence that it can prolong life among younger 
women, especially women 50 and under.  And the truth is that it 
will depend upon the doctor's belief that it should be the 
appropriate course of medical care.  But what we're trying to do 
is to give these decisions back to doctors and their patients who 
believe it's an appropriate course of medical care.  And I think 
that it is clear that we're moving to the point where most 
physicians believe that there are circumstances under which it is 
an appropriate thing to do to give women with breast cancer bone 
marrow transplants.  
	     
	     But I'm not trying to give you an evasive answer, 
I'm trying to give you the standard that will be used in the 
insurance policy -- is it appropriate medical care?  Will the 
doctor believe that?  I think that more and more doctors do 
believe that so, in most cases, I think you can look forward to 
that kind of procedure being covered.  Thank you.
	     
	     MS. ASTORE:  Let's bring the audience in Milwaukee 
into the discussion now.  
	     
	     Q    Thank you very much.  It's been most 
interesting thus far.  Will Vanessa Donovan please come up?  I'd 
like to have you ask your question if you are here.  Vanessa's 
coming over now to -- step right this way, Vanessa, if you will 
and I'll meet you sort of halfway here.  
	     
	     We are -- it will be interesting for the audience 
here to know, they can't hear us in Minneapolis, which is more 
than we've been able to say for much of the program.  What was 
your question for the President?
	     
	     Q    Okay, my main question is, a year ago, my 
insurance was perfect.  Shortly after your reform came into the 
public eye, my insurance company notified us that in order to 
keep our insurance the same, it would cost us $1440 more per 
year.  There's three doctors that I see on a regular basis --
they're specialists.  I went Wednesday, and a big sign on his 
desk said, in order -- you must have a current referral every day 
-- I mean every appointment.  And also I called my insurance 
company and they said --
	     
	     Q    Can you get to the point of the question?
	     
	     Q    The question is if I have to pay for two 
doctors' appointments, how is that cost effective?
	     
	     Q    Okay, thank you.  Mr. President?
	     
	     THE PRESIDENT:  Well, first of all, let me say that 
a lot of that referral business is probably because of 
requirements that the insurance companies have put on the doctors 
treating this lady.  If you talk to any doctor, they'll tell you 
that more and more and more, they're having to call insurance 
companies and get permission to practice medicine in advance of 
doing what they think has to be done anyway.   Last night I was 
down in Kansas City and I had three doctors in our group there, 
and that's all they talked about was how much time they were 
spending getting the approval of insurance companies to do what 
they knew to do anyway.  
	     
	     You talked about how much your insurance had gone 
up.  Let me say, one of the best things about having a national 
reform is that you can charge people the same price for an 
individual policy and a higher price for a family policy, but you 
would pay that price even if you had to use the doctor enough.  
That's what insurance used to be.  
	     
	     I mean, when Blue Cross first got organized, 
everybody was lumped in a great big pool, everybody paid the same 
amount.  Some people got sick and the rest of us paid for that as 
well as a hedge against ourselves getting sick.  Now we have 1500 
separate insurance companies, thousands of different policies, 
hundreds of thousands of people working in doctors' offices and 
hospitals and insurance offices figuring out who's not covered 
for what.  So if you're in a little pool, and this lady -- you 
heard what she said, she has an illness -- your rates can go way 
up.  If we're all insured in large pools, then your rates would 
not go up unduly -- just more or less at the rate of inflation -- 
just because you had an illness.  That's one of the -- this woman 
would be dramatically advantaged if we had national insurance 
reform -- health care reform.
	     
	     MR. MEIER:  Mr. President, I'd like you to meet this 
46-year-old man from Milwaukee.  He is HIV positive, the father 
of two grown children.  He is an unemployed factory worker, soon 
to be without insurance.  What is your question for the 
President.
	     
	     Q    Mr. President, I want to say thank you for 
bringing this to the forefront and Mrs. Clinton.  My question is, 
why can't the best of what the Canadian health care has and the 
German health care have be brought to us as a package for the 
American people?
	     
	     THE PRESIDENT:  Well, that's kind of what we're 
trying to do.  The Canadian system -- in Minnesota, for example, 
where you're close to Canada, or in Michigan, or any of the 
states that are in our program tonight, there are a lot of people 
who would like to see the single-payer system that the Canadians 
have.  
	     
	     The problem is twofold.  One is, it would be very 
difficult to get Congress to agree, in effect, to put all the 
health insurance business in America out of business and 
substitute it with a tax.  And a lot of people like the lady who 
asked the second question here would wonder what that would do to 
their health care plans.  Secondly, the Canadian system, in my 
judgment, has not had quite as much success at controlling costs 
as the German system has, where all the people pay something, 
assume some responsibility directly for their health care, and 
therefore negotiate more vigorously on an ongoing basis to try to 
hold down the costs of health care.
	     
	     But let me say from my point of view, sir, to you, 
there are lots of people in America who are HIV positive who 
could be working; who could be making a contribution and paying 
taxes; who have difficulty doing that because they can't get 
health insurance.  But if they were insured in very large pools, 
they would be able to do so.
	     
	     So I think that one of the most important 
beneficiaries of this policy will be people who have very serious 
illnesses that still may permit them to work for long periods of 
time and be active if they can provide for their own health care 
needs.
	     
	     MS. ASTORE:  Thank you, Milwaukee.  We have one more 
live location to bring into our town hall meeting tonight on 
health care.  
	     
	     Q    Mr. President, we have with us tonight a person 
who has perhaps slightly a nontraditional type of view of how 
this might impact the health care industry.  We have with us this 
gentleman who is a chiropractor here in Sioux Falls.  Your 
question for the President.
	     
	     Q    Mr. President, 34 percent of the office visits 
to practitioners according to the New England Journal of Medicine 
are to nontraditional practitioners, such as chiropractors, 
acupuncturists, massage therapists and nutritionists.  How will 
we be covered in your new health care plan?
	     
	     THE PRESIDENT:  Well, what we do in the health care 
plan is to require certain kinds of care to be covered.  And then 
that care can be provided in a variety of different ways by 
anybody who is qualified to provide it.  What will happen is that 
the people who band together in these purchasing alliances will 
be given any number of choices from which the consumers of health 
care can choose what kind of health care plan they want.  So all 
consumers will have the option, if they wish, to choose plans 
that have different kinds of providers including alternative 
providers, as you mentioned, to provide various health services.  
We have to have -- everybody by law has a right to have three 
different kinds of plans -- kinds of plans.  But what you'll have 
in most places is the kind of choices that now, for example, 
federal employees have.
	     
	     You know, a lot of federal employees can choose 
between two dozen different plans.  It's amazing.  And as a 
consequence of that, you have all different kinds of options and 
a lot of providers, including chiropractors, have a chance to 
provide services to people.  That's the way ours would be set up.
	     
	     Let me go right to the heart of the question because 
I've got a lot of friends who are chiropractors who have asked me 
this.  We do not specify in the bill as it is presently drawn the 
services of chiropractors, osteopaths, nurse practitioners or 
neurosurgeons for that matter.  What we do instead is say, here 
are the kinds of health care services that have to be ordered, 
let people organize themselves and offer them to the consumers of 
America.
	     
	     MR. MEIER:  In South Dakota we're in an area that's 
a lot more rural than the other areas represented in this 
program.  Tonight we have with us a woman who is a physician's 
assistant in one of those rural areas.
	     
	     Q    Good evening, Mr. President.  As a practicing 
physician's assistant, I see significant increase in the cost of 
health care as physicians, physician's assistants and nurse 
practitioners practice defensive medicine in a litigious society. 
Providers are obligated to order extensive tests and treatments 
to protect themselves from potential malpractice suits.  If 
health care costs are to be reduced, attention must be directed 
at health care, at tort reform.  Will you health care plan 
address this problem as health care reform becomes a reality?
	     
	     THE PRESIDENT:  Our plan does that in two ways.  Let 
me also mention, since we're talking to South Dakota and you've 
got a lot of rural population, although we do here in Minnesota, 
too, and in Michigan, the other states that are represented and 
in Wisconsin. 
	     
	     Another big problem that we have in my rural state 
where I'm from is that more and more general practitioners out in 
the country are reluctant to do things like deliver babies and 
set simple fractures because of the malpractice problems.
	     
	     Our bill does two things:  one is it sets a limit on 
the percentage of a malpractice judgment that can be taken by a 
lawyer, a percentage of the contingency fee; the second thing it 
does, which I am convinced will have a far more positive impact 
on insurance rates,  is it sets up a system in which the 
professional associations set up medical practice guidelines for 
various kinds of cases.  And then if the physicians can 
demonstrate that they follow the guidelines, there is a 
presumption that the physician was not negligent.
	     
	     Now, that presumption can be overcome, but it is 
much harder.  And if that happens, we believe, that there will be 
a substantial reduction in the number of frivolous cases in the 
malpractice area, and therefore, malpractice insurance rates will 
go down.  
	     
	     That's been tried in a rural state, Maine, with some 
considerable success.  And I think that it's the best way to go 
to guarantee lower malpractice fees and still give people a right 
to go into court when they've genuinely got a gripe.
	     
	     MS. ASTORE:  We're going to take this opportunity to 
give the President a breather.  So relax, we're going to take a 
short break, and we'll be right back.
	     
	     
			    * * * * *
	     
	     MS. ASTORE:  Welcome back everyone to "Health Care 
in the Heartland", our town hall meeting in the Twin Cities with 
the President.
	     
	     MR. MEIER:  Coming up we have a profile of a person.  
One of the scariest scenarios we've heard over and over again 
from callers here in the Twin Cities is, what happens when 
someone loses their health insurance during a time when they 
really need it.  And here's one such story.
	     
	     ( A film is shown.)  
	     
	     Q    Mr. President, health care is certainly a 
difficult issue and one that has many components to it.  Can you 
address how the new plan would handle insurance as you go from 
one employer to another; and also how changes in the economy as 
well as profitability of companies could handle and affect the 
funding of the health plan.
	     
	     THE PRESIDENT:  Thank you very much.  You know, this 
is so interesting.  Of all these forums that I've done, you're 
the first person that's asked me that question.  And let me try 
to explain how it would work.
	     
	     First of all, under our plan, companies would be 
free to self-insure if they were above a certain size.  We now 
have 5,000 and above.  There are some in Congress who think it 
should be smaller.  But what we have is complete portability of 
benefits so that no family can never be without benefits.  So 
that if your company goes down and you don't have another job, 
you just carry your benefits.  And for the period in which you're 
between jobs, this reserve fund that I talked about that we'll 
set up, the government basically would provide the reserve to 
guarantee that your coverage would continue just as if you were 
still working at the other company.  So you would not have been 
put in the position that you're in now.
	     
	     And it's very important.  In addition to people who 
are in the position that you're in, where your company went broke 
and you got left with all those bills, there are an awful lot of 
people who just want to change jobs, but they have to wait for 
months and months and months, even after they change jobs, before 
they actually get coverage.  So this is a big issue.
	     
	     We need to guarantee -- the term of art is 
portability -- complete portability of policies through jobs and 
through employers.  And our system would provide that.
	     
	     Thank you.
	     
	     MS. ASTORE:  Mr. President, this gentleman is from 
North St. Paul, and he's concerned about benefits to immigrants 
to this country.  Your question.
	     
	     Q    Mr. President, in your health care plan, you 
say you want all Americans to get involved in the process of 
planning so that all American citizens will benefit from the 
plan.  However, there are -- adult literacy surveys indicate 
there's 21 to 23 percent of adult or 40 to 44 million adults were 
less skilled level.  And 25 percent of adult or 10.5 million 
adults were immigrant with limited English skills.  And I ask, 
what is your plan to insure or access to your health plan system 
for this unique American citizen and alien resident?
	     
	     THE PRESIDENT:  Most of those folks, even with very 
limited English capacity, have jobs.  So they would get -- at the 
job site -- a card, a health care card, just like everyone else; 
which they then would be able to present to their doctor.  They 
would have the opportunity either at work or at a local health 
clinic to have explained to them what their choices are of the 
health care plan, and then they would just -- they wouldn't have 
to keep up with a lot of paper or anything, just one card for the 
family that they could present at the health care clinic when 
they needed it, or at the hospital.   So I think that's the way 
it will work.
	     
	     Now, in many places where there are a very large 
number of people whose first language is not English, we will 
have to expand the outreach activities of the public health 
clinics for people who are not employed, and where there's no one 
in the family who is employed.  And we understand that we're 
going to have to do that and make some provision for doing that.  
Thank you.
	     
	     MR. MEIER:  Mr. President, we're going to join our 
satellite audience one more time in Detroit and station WDIV. 
	     
	     Q    And first we want to apologize for the audio 
problems that we've been experiencing here in Detroit.  We are 
working very closely with the people in Minneapolis to get that 
corrected, we ask that you do be patient and stay with us.  

	     Right now we're going to take a question for the 
President from this woman who is the Secretary for the National 
Association of Engineering Companies.  And what is your question 
for the President tonight?
	     
	     Q    Mr. President, I would like to know how 
prescription coverage will be affected under the plan outside of 
Medicare?
	     
	     THE PRESIDENT:  Under our plan, every health policy 
would have to have a prescription drug component which would have 
the following characteristics:  There would be a $250 deductible.  
In other words, you have spend up to $250 of your own money on 
medicine before it would trigger in.  And then after that, every 
prescription would require a 20 percent co-pay.  But there would 
be a ceiling beyond which you could not spend -- it's about 
1,000.  If your expenditures went over $1,000 a year, then the 
insurance policy would cover all the prescription drugs that your 
doctor would require and that your health would require.
	     
	     So it's a pretty good policy, because -- now, if you 
have a better policy now, you can keep it.  Keep in mind, if the 
coverage is better now, you can keep it.  But almost no one has 
coverage that good today in their health care policy for 
prescription drugs.  And there are a lot of national studies 
which show that the adequate provision of prescription medicine 
can actually save money by reducing hospital stays and emergency 
room visits.
	     
	     MS. ASTORE:  Okay, now, since we got that question 
out, we've got another one for you, Mr. President.  It's from 
this woman who is an American citizen living in Windsor.  And 
what is your question for the President tonight?
	     
	     Q    I wonder if he knows about Ontario's latest 
plan that preventage of medicine consists of community health 
centers run by the community, staffed by salaried practitioners, 
concentrating on long-term health problems within each community.  
They're running 49 such centers at a cost approximately the same 
as a large hospital.
	     
	     MS. ASTORE:  And that's in Canada.
	     
	     Q    This is in Ontario.
	     
	     THE PRESIDENT:  I think that one of the things that 
will happen if we pass this bill is that you will have more and 
more health care provided in that way by community-based clinics 
or comprehensive health centers that have salaried professionals, 
including doctors.  Interestingly enough, we're here in 
Minneapolis -- that's what you have at the Mayo Clinic, right?  
Everybody concedes that there is no finer health care in the 
world.  And yet I have many people who have been patients at the 
Mayo Clinic tell me that it is less expensive than they what they 
paid back home for other kinds of care.  
	     
	     So I think that you will see a lot more of that in 
this country once the health insurance market is organized so 
that people know they will always be reimbursed for the services 
they provide.  That then permits people to organize these kinds 
of associations and know that they'll be able to run them without 
going broke, because they know they'll always have reimbursement.
	     
	     Q       why this woman moved there to begin with, 
right?
	     
	     Q    That's true.  It was an unexpected bonus.
	     
	     MS. ASTORE:  We're going to go back now to our 
Milwaukee audience.
	     
	     Q    Thanks.  There are people in Milwaukee who have 
already taken health care reform into their own hands.  With me 
now is this doctor.  And the clinic he works in is a model for 
the Clinton health plan, and is already making a difference here 
in Milwaukee.
	     
	     (A film is shown)
	     
	     Q    Dr. Sanchez, what is your question for the 
President?
	     
	     Q    Mr. President, do you feel it is important to 
preserve the established network of community health centers 
across the country?  And if so, how do you address this in your 
health plan?
	     
	     THE PRESIDENT:  Yes, I do.  Not only for the reasons 
we just saw in the fine practice you have, but because the 
community health centers are increasingly providing services to 
large numbers of people who used to not use them at all.  For 
example, in many of the southern states of this country, 
including mine, over 80 percent of all the children in the states 
get their immunizations through community health centers, because 
a lot of regular doctor's offices don't do it anymore because of 
the malpractice problems that were mentioned earlier. 
	     
	     So I think it's very important.  And our plan has a 
special provision for funding community health centers at a 
higher level to try to make sure that these kind of comprehensive 
services can be provided.  
	     
	     And let me emphasize, too, that in the inner city 
and in rural areas -- we've got South Dakota here, remember, on 
this television program -- if it weren't for community health 
centers there would be no access to health care; so that people 
might have insurance but they still wouldn't have any place to go 
with their insurance.  So it's very important.
	     
	     Thank you for practicing there.
	     
	     MR. MEIER:  Our next question's from this gentleman, 
who is a cigarette and grocery supplier.  And you have a question 
with regard to the tax on cigarettes, which is being discussed in 
regard to this.
	     
	     Q    Mr. President, this country was based on 
tobacco farmers exporting their product overseas.  Today it's 
been proven that the people least likely to afford cigarette 
smoking are the ones that are left smoking today.  Why would you 
place such an unfair burden on one group of people and one 
industry to pay for all this?
	     
	     THE PRESIDENT:  Well, as I said, first of all, let 
me say if I could figure out how to get enough savings out of 
this program to pay for it without any tax, that's what I would 
do.  We are going to get dramatic savings out of this program, 
mostly by having a single form, simpler administration, which 
will save the taxpayers a lot of money; and those of you who 
aren't taxpayers who have private insurance, by drastically 
cutting the amount of administrative overhead in the system.  
	     
	     We cannot, however, provide enough money to do the 
things that we've been discussing without raising some money.  
Obviously, I think it is fair to ask the companies that will have 
the biggest drop in their insurance premiums to give a small 
portion of that to the fund for small business discounts and for 
unemployed people.
	     
	     The reason that I think that the cigarette tax is a 
legitimate place to get funds is that cigarette smoking is the 
only activity that we know of in our society that there is no 
know safe margin for doing.  That is, it's not like alcoholic 
consumption where if you're not prone to be an alcoholic there 
are safe margins of consumption.  We know of no safe measure of 
smoking.  And we also know that several thousand people year get 
lung cancer from subsidiary exposure to smoke, when they don't do 
it themselves.  We also know that our society bears a health care 
burden and cost as a result of the health care consequences of 
smoking far in excess of the money raised from the cigarette tax.  
So for all those reasons, I thought since we had to raise some 
money, that was the fairest way to do it.
	     
	     MS. ASTORE:  There are millions of Midwest residents 
who live in rural areas who have some unique issues when it comes 
to health care.  Mr. President, we're going to take another 
break; we'll talk about that when we come right back.  
(Applause.)
	     
			    * * * * * 
	     
	     MR. MEIER:  And welcome back to "Health Care in the 
Heartland," our town hall meeting in the Twin Cities with 
President Bill Clinton, obviously.  
	     
	     We're going to toss it out to Sioux Falls, South 
Dakota, where we have more questions for you from the heartland.  
Mr. President.
	     
	     Q    South Dakota is among the most rural states in 
the nation.  We have several hundred thousand people spread out 
over the entire state, not just in one city.  Small business 
people, the self-employed and those with existing medical 
problems all have a big stake in the health care reform problems.
	     
	     (A film is shown.)
	     
	     Q    We're back now and we have with us a farmer 
from South Dakota, and he has a question for the President.
	     
	     Q    Do you have it built into your plan to 
encourage more organ donation amongst -- to get more organs 
available and when they do become available, to use for 
transplants?  That's my question.
	     
	     THE PRESIDENT:  Yes, sir.  We support transplants as 
I said, let me restate -- particularly organ transplants.  We 
support transplants when they are the recommended medical 
procedure, and we try to provide ways to make sure that we 
facilitate that.  
	     
	     Now, let me also say to you since you were 
introduced in a slightly different way -- as a farmer who's self-
employed, who has already had a medical problem, who has folks 
working for you on the farm.  Farmers, in my opinion, may be the 
biggest winner in the proposed reform we have because today, 
believe it or not, self-employed people who buy health insurance, 
number one, pay exorbitant rates anyway because they're not in 
big pools.  If they've been sick, they pay lots more.  And if 
you're self-employed, you can only deduct 25 percent of your cost 
of the premium from your income taxes whereas a business can 
deduct 100 percent.
	     
	     Under our plan, you'd be able to buy on an equal 
basis with others in a much bigger pool and you would be able to 
deduct 100 percent of your self employed premium which means in 
almost every case in the country, farmers would be able to insure 
their farm hands for the time they work for them and their 
families for less than they're paying just for family insurance 
today.  And you certainly would because of your preexisting 
condition.
	     
	     But, let me just say this, I will try to get some 
more information on the specific question you asked me about 
encouraging and organizing the whole market for transplants.  And 
I will make sure that we get back to you in the next day or two 
with a more specific answer to your question.
	     
	     Q    Mr. President, also joining us today is the 
president of the South Dakota's Farmers Union.
	     
	     Q    Thank you.  It's nice to have you around, Mr. 
President.  It was nice to have your wife here previously.  It 
was an excellent opportunity for the people of South Dakota.  
	     
	     One of the things that concerns many of us is, 
number one, to maintain the farmers out there, but as the farmers 
are maintained, to require them or have the ability to have the 
infrastructure in the small towns.  As I understand it, this plan 
will provide monies to develop that infrastructure.  Would you 
please elaborate?
	     
	     THE PRESIDENT:  Yes, I'd like to talk about that a 
little bit.  And I'd like to say, first of all, my wife had a 
wonderful time out there.  And I want to thank Senator Daschle 
for doing such a good job and working on this rural health care 
issue.
	     
	     Let me try to explain how this would work, and let 
me say for the rest of you, a lot of people who live in small 
towns in rural areas don't even have a doctor in their town 
anymore.  I met in rural North Carolina earlier this week a 
doctor who told me she was working 110 hours a week and had been 
several weeks, but she had just come to her slow season when she 
could work 80 hours a week.  Now, that's a doctor who's going to 
need a doctor pretty soon, right?  (Laughter.)
	     
	     Here's what we try to do.  Let me briefly run 
through the things that are in this plan for rural areas.  Number 
one, revive the National Health Service Corps where young doctors 
can pay for their medical education which normally leaves them 
with a big debt by serving in underserved areas -- 7,000 doctors 
over the next few years doing that.
	     
	     Number two, give doctors and other health care 
providers who go into underserved areas significant income tax 
credits as incentives to do it -- $1,000 a month for doctors, 
$500 a month for nurses and other medical professionals for up to 
five years.  That's a huge incentive.  Number three, give doctors 
faster write-offs, tax write-offs when they buy modern equipment 
to put into their clinics in rural areas.
	     
	     And number four, make sure that we've got the 
technology, the computer technology to connect rural clinics with 
urban medical centers so doctors can feel good about the quality 
of their practice when they're out there and feel like they're 
giving their patients the kind of care they need.
	     
	     Those are the things that we think will get a lot 
more doctors and nurses and other into rural America and make a 
big difference.
	     
	     Q    Mr. President, we also have another farm group 
in South Dakota that is quite large, the South Dakota Farm 
Bureau.  And we have along with us tonight Gayle Brock from the 
Farm Bureau.
	     
	     Q    Mr. President, I would like you to ask you to 
comment on Medicare and Medicaid.  They are often under-
reimbursed in the rural areas for those that provide care in the 
rural areas.  And how can these providers then be adequately 
compensated and still save over $100 billion, as you have 
outlined in your financing proposal on these two programs?
	     
	     THE PRESIDENT:  Well, for one thing, Medicare and 
Medicaid are going up right now at two and three times the rate 
of inflation -- by far more than inflation and population growth 
-- because primarily of the way the Medicaid program is 
organized.  Under our plan, Medicaid recipients would be put into 
big insurance pools along with all other -- along with small 
businesspeople, self-employed people, and larger business people.  
In other words, they'd be put in these big community pools.  And 
doctors, for the first time, would be reimbursed at the same rate 
whether or not they had a Medicaid patient or someone who was 
privately insured.  It would be exactly the same reimbursement.  
And that would make a huge difference to the physicians.
	     
	     Secondly -- and how would we do that and still save 
money?  Because you'll have competition; you'll have managed 
competition, which we've seen already in Minnesota with the work 
that's been done here.  You had dramatic drop-off in the increase 
in medical costs here as people have organized themselves into 
larger groups.
	     
	     Secondly, under Medicare, we leave it the way it is 
because so many of the people that I have talked to in the AARP 
and the other groups believe Medicare works and want it left 
alone.  But we do add a prescription drug benefit and we add a  
long-term care benefit.
	     
	     How will rural doctors be able to deal with this?  
They won't have any more uncompensated care.  One of the things 
that makes Medicare and Medicaid a bigger burden in rural areas 
is there are an awful lot of uncompensated care in rural areas.  
Now doctors will be paid something by everybody they treat.  And 
I believe that that will make a big difference to the quality and 
rewards of the practice of medicine in rural areas.
	     
	     We can save this money -- to go back to your 
question -- by the way we organize the health care markets and by 
making sure that everybody is reimbursed for all the services 
that are provided.  Then we'll be able to lower the rate of 
inflation.  
	     
	     Keep in mind, we don't propose to cut Medicare and 
Medicaid, ma'am.  Medicare and Medicaid under our proposal would 
go up at twice the rate of inflation, instead of three times the 
rate of inflation, which it's going to do if we don't pass 
national health care reform.
	     
	     MS. ASTORE:  Back here in the Twin Cities, Mr. 
President, we have a question from a woman of St. Paul.  She's 
concerned about the importance of mental health care under your 
program.
	     
	     Q    Mr. President, initially, mental health care 
seemed to be an important part of health care reform.  But 
recently I haven't heard much about its inclusion within the 
reform package.  My question is, is mental health care an 
important part of health care reform; where and how is it going 
to fit in?
	     THE PRESIDENT:  Yes, it is a very important part of 
health care reform.  We have -- under our plan, some mental 
health benefits would be included from the beginning of national 
health reform.  That is, whenever -- all the states would have 
until the end of '97 to provide universal coverage.  Each state 
would have that time.  From the beginning of the time everybody 
was covered, there would be significant mental health benefits, 
much more than most people have under their policies today --both 
in-patient and out-patient care.
	     
	     There would not, however, be complete parity.  And 
if you're interested in mental health, you know  -- parity 
between the mental health benefits and the physical health 
benefits until the year 2000.  And that's because we don't have 
accurate cost estimates on how much it will cost and we have to 
phase it in.  To go back to what some other people had said 
earlier, we have to know that when we put these things in that we 
can pay for them and we're not going to cost the Treasury more 
than we have.
	     
	     But there will be quite a significant mental health 
benefit from the very beginning and much more than most people 
have today.  I think it's very important.  I think it's one of 
the best things about our plan, and I personally believe it will 
make us a healthier country and will cut down on long-term 
medical costs if we have proper kind of mental health.
	     
	     MR. MEIER:  Mr. President, if I could have you do an 
about-face -- (laughter) -- and direct your attention right up 
here.  We had a lot of questions about costs of a national health 
care when we organized this forum.  Brian Malloy is from 
Minneapolis, and I believe he'd like to ask you a question on 
that topic.
	     
	     Q    Mr. President, we already have Minnesota Care 
in this state and we've enrolled 30,000 Minnesotans in this plan.  
Are we going to lose money under a federal plan?  Would we be 
better off to continue with Minnesota Care independent of a 
federal initiative?
	     
	     THE PRESIDENT:  No, you won't lose money because --
and I commend what you've done; I think it's important.  But you 
won't lose money.  We estimate that both private insurers and the 
government will save money if we go on with national health care 
reform.  And what will happen is if we have the national plan, 
we'll be able to do some things that at least you're not now 
doing.  
	     
	     First, everybody will be able to be insured.  And, 
secondly, in addition to holding costs down, we'll be able to 
hold costs down with more choices for health care consumers than 
you're going to be able to provide unless we have a national plan 
which reorganizes the insurance markets.  So my judgement is, 
you'd be -- I would urge you to keep going with you reforms here 
to do the best you can and go full out until the Congress acts.  
But I believe you'd be much better off when the Congress acts.
	     
	     MS. ASTORE:  Mr. President, another question from 
Minneapolis.
	     
	     Q    Mr. President, untreated addiction is a huge 
factor in the rising cost of health care.  The American Medical 
Association tells us that about 40 percent of hospital days and 
over 50 percent of emergency room visits are for alcohol or other 
drug-related causes, illness or accidents.  I'd like to know with 
your benefit for a substance abuse treatment which, as you 
mentioned, is there now -- along with the mental health -- you've 
been taking a lot of flack on the cost.  But we know that 
treatment cuts medical utilization in half immediately not only 
for addicted persons, but for their whole family members.  Can 
you do a better job of defending that?  And how far are you going 
to go to keep this benefit in the final legislation on health 
care reform?
	     
	     THE PRESIDENT:  I don't know if I can do a better 
job of defending it.  Some days I don't think I do such a hot 
job.  (Laughter.)  I did my best when we started tonight, but I'm 
going to try.  Let me say -- I think you may know this -- but I 
have a brother who is an addict, who is a recovering addict.  I 
know the treatment works.  
	     
	     And we have done two things in our administration.  
One is to require that drug treatment be a part of the benefits, 
as a part of a general approach to preventive health care.  I 
believe in preventive health care, folks.  We spend a ton of 
money after the cow's already out of the barn door in our health 
care system.  And I like -- I mean, I like the fact that we have 
the best technology in the world.  I like the fact that we can 
get it.  But we can save so much money if we just invest in 
prevention generally, whether it's mammograms for women or 
cholesterol tests for people or substance abuse treatment.
	     
	     In addition to that, although I just presented a 
budget to the Congress that cuts defense and cuts discretionary 
domestic spending -- that is, not Medicare, Medicaid or Social 
Security -- for the first time since 1969.  We increase in our 
regular budget drug treatment funds by, oh, about 8 or 10 
percent, just because I think it is so important.  And I will 
fight very hard for it.  I think it would be a big mistake for us 
to back off of this.  There's still an awful lot of people who 
have alcohol and drug abuse, substance abuse problems in this 
country.  And we can save a bunch of money and a lot of people, 
more importantly, if we stay with it.
	     
	     MR. MEIER:  Before we move on, we want to apologize 
to our satellite audiences.  We understand they've been 
experiencing some technical difficulties.  We know how important 
this forum is.  And we apologize for that.
	     
	     In the meantime, let's move onto Detroit for another 
audience there.
	     
	     Q    All right.  I know from Detroit, we really do 
thank you for that.  With me is this woman, and she's been 
waiting patiently for quite awhile.  She's a mother of five, a 
grandmother of one.  You've lived in Detroit for 30 years, you 
work with senior citizens.  What's your question for the 
President tonight?
	     
	     Q    My question, Mr. President, is, will there be 
coverage for seniors for medication, and full coverage, in fact, 
for those people who are most likely to need it?
	     
	     I work in an office where I see seniors who are 
going to doctors maybe three, four times per month, and they can 
hardly afford to eat if they buy their medication.  Will there be 
some type of relief or help with medications for those people.
	     
	     THE PRESIDENT:  Yes, ma'am.  Let me explain this 
again for the benefit of all of our participants here.  Older 
people who are at or below the poverty line are eligible for 
coverage under the Medicaid program, the government's program for 
poor folks.  If you're under Medicaid, then you have a 
prescription drug benefit.  But if you're a senior citizen 
eligible for Medicare --that is, the regular elderly person's 
health care program -- and you haven't spent yourself in poverty, 
you don't get any prescription drug benefit.  But we know that 
older people are four times as likely to use medicine as younger 
people.  And we also know that we save money in our health care 
system if people who need medicine get it and can therefore stay 
out of hospitals.  I mean, you can spend a year's worth of 
medicine in three days in a hospital.
	     
	     So what our plan does is to add to Medicare a 
prescription drug benefit, which has a $250 deductible, a 20 
percent co-pay and, I think, a $1,000 ceiling -- it has a ceiling 
and I think it's $1,000.  That is, after you spend $1,000 out of 
pocket, your insurance then will cover all your medicine from 
then on.
	     
	     MS. ASTORE:  Okay, our next question comes from a 
health economist at the U. of M. School of Public Health -- the 
University of Michigan.  Welcome, and what's your question for 
the President?
	     
	     Q    Well, my question is, one of the important 
principles behind health care reform is that an increasing 
reliance on competition to control costs.  However, what we see 
in many markets already is consolidation of insurers and 
providers into larger and larger groups.  My question is, what 
steps would you advocate to ensure that, in a situation that 
seems to be evolving to even very large cities having two or 
three big players in the health insurance market -- what steps do 
you advocate to ensure the competition will remain viable in the 
long term?
	     
	     THE PRESIDENT:  
First, let me say, I think there has to be some consolidation of 
the insurance market.  To be fair, I've tried to say this over 
and over again -- and sometimes not so well -- but, I don't think 
there are any bad people in this drama.  We have the best health 
care in the world -- we have the best doctors, the best nurses, 
the best medical technology, the best medical research.  We have 
the worst health care financing system in the world.  It is the 
world's most expensive; it's estimated by nearly everybody that 
studies it that we spend about $90 billion a year -- which is 
pretty good money -- in clerical work, simply because of the way 
we're organized.
	     
	     I think there should be and will be, inevitably, 
some sort of insurance consolidation.  How do we guarantee 
competition?  By requiring that in every group of buyers, every 
consumer in America have access to at least three different kinds 
of plans -- a fee-for-service plan, a health maintenance 
organization, a professional provider organization.  
	     
	     They may have access to 24 specific plans -- as I 
said, the way the federal government employees often do today -- 
but we will guarantee that every person always has access to at 
least three different kinds of plans, including fee-for-service 
in the old-fashioned way.  When you do that, you're going to 
ensure that there will be more competition than there will be.  
If we do nothing, the move toward competition, in my judgement, 
will be just exactly what you say -- there will be more and more 
concentration, more and more managed care, but less choice, less 
quality and less competition.
	     
	     MS. ASTORE:  Now, we've heard from an American who 
moved to Canada.  Our next question comes from a Canadian who has 
moved here to America.  You owns a small business, and what is 
your question for the President?
	     
	     Q    Mr. President, you have said that I will not 
have to give up my doctor.  Right now, my family uses several 
doctors.  Under your plan, what if these doctors work for 
different alliances in my area?  Won't I be forced to choose 
which alliance I want to join and thereby give up one of the 
doctors I now see?
	     
	     THE PRESIDENT:  No.  But let me answer your question 
directly.  First of all, one option you will always have, ma'am, 
is to continue to pay your doctors as you would now, on a fee-
for-service basis.  Your premiums might be slightly higher, but 
they probably still would be as low, if not lower, than they are 
today because of the way the markets are organized.
	     
	     In addition to that, you can also join a certain 
plan -- like a certain health plan -- and maybe all your doctors 
aren't members of it, let's say three are but one of your 
specialists aren't.  You can buy a small premium, which would not 
be very expensive, which would give you the right also to use 
that doctor, who would then get reimbursed from your plan at the 
same rate other doctors in the same specialty or the same area 
would.
	     
	     So you would be able to keep all your doctors.  That 
would be one of the things you'd have to do.  You might have to 
pay slightly more to do it than you would otherwise pay.  But you 
could keep them all and, in all probability, based on our 
studies, it would be for the same or less money than you're 
paying now.
	     
	     Q    I think we should mention that we have one of 
the friendliest --
	     
	     THE PRESIDENT:  If you have a comprehensive plan.
	     
	     Q       international borders, probably, in this 
country between Detroit and Windsor, Ontario, Canada.  Back to 
you in Minneapolis.
	     
	     MS. ASTORE:  Thank you.  We'd like to go now to our 
Milwaukee audience at WISN-TV.
	     
	     Q    Thanks, she is a 29-year-old college graduate.  
She is the mother of three, she is bilingual, she wants to work, 
she can't find a job and begins to think that maybe we're 
approaching the wrong problem first.
	     
	     Q    Yes.  Mr. President, my concern is welfare 
reform.  As it is true with any reform effort, the basic purpose 
for welfare reform is to increase and expand the opportunities 
and benefits for the people on it to enable them to be self-
functionable.  Therefore my question, Mr. President, how does 
your proposed welfare reform program expand and increase the 
opportunities for myself -- a welfare recipient who has went to 
high school, has received a high school diploma; who has attended 
and graduated a state-accredited four-year university, has 
received a Bachelor of Arts degree in Communication, bilingual in 
Spanish; who has also acquired computer proficiency in 
WordPerfect, Work Express, Wendalls, Lotus --
	     
	     Q    Now we know what job she's looking for.  What's 
your answer Mr. President?  (Laughter.)
	     
	     THE PRESIDENT:  My guess is we've already done it.  
I'll bet you'll have four job offers tomorrow since you've been 
on television.  (Laughter.)  I imagine we probably solved your 
problem.  But let me give you a more general answer.  I hope 
somebody who's watching you will call you and offer a job 
tomorrow.
	     
	     First of all, quite apart from welfare, we have to 
create more jobs in this country.  In the last 15 months, our 
economy has produced two and a half million new jobs -- 90 
percent of them in the private sector, more than in the previous 
four years.  So we're creating more jobs.  That's the first 
thing.
	     
	     Secondly, with regard to welfare, how do you move 
people from welfare to work?  You have to make work more 
attractive.  We, this year, starting in this calendar year, we 
are lowering income taxes for 16.6 percent, one-sixth of American 
workers who make lower wages to make sure that work will always 
be more attractive than welfare by saying, if you work for modest 
wages, you'll get an income tax cut.
	     
	     The third thing we are trying to do is to reform the 
welfare system itself by helping to create jobs ultimately for 
people who have training and are able to go to work, if 
necessary, with some sort of public funding.  But let me say, it 
doesn't apply to you.
	     
	     But the biggest problem we've got with welfare for a 
lot of people is that -- remember, if you're poor on Medicaid and 
on welfare, your children get health care.  If you take a minimum 
wage job in a business that doesn't have health insurance, you 
have to give up your kid's health care to go to work.  Then you 
work for a minimum wage and you pay taxes so people on welfare 
can have health care.  It doesn't make any sense.  So, the health 
care issue is an important part of welfare reform.
	     
	     The answer to this lady's question is she should be 
able to get a job in a healthy market economy.  So we have to 
create more jobs.  Ultimately, for people on welfare who are 
willing to go to work, if they can't find jobs within a certain 
specific time, in my judgment, the government is going to have to 
work with the private sector to give extra incentives for people 
to go to work.  It's better to have work than be on welfare even 
if you have to give extra incentives to create the jobs.
	     
	     Q    Our next person who would like to ask you a 
question is this gentleman.  He's 17 years old, still in high 
school, has done a great deal of research on this entire project, 
and has drawn the conclusion that it will not work.  (Laughter 
and applause.)
	     
	     Q    Good evening, Mr. President.  I don't know if 
that's exactly correct, but how will you nationwide health care 
program affect the American free enterprise system as we know it?  
Will it simply be a case of government stepping in and improving 
the status quo while maintaining the private business -- private 
health care industry?  Or is it more like a reinvention of the 
American health care -- improving conditions for Americans, but 
hurting the private business sector?
	     
	     THE PRESIDENT:  I think it will do much more good 
than harm.  There will be some job loss in some areas, and there 
will be some job gain in some areas.  And let me explain how and 
why I think it's the right thing to do.
	     
	     First of all, the system is entirely private.  We 
require people to purchase insurance.  We keep private insurance.  
We do not abolish insurance and substitute taxes.  Secondly, all 
the health care providers that are now private will continue to 
be private.  So we leave that alone.  But if you go to a 
comprehensive benefit program where you have a single form that 
the doctor has to fill out, a single form that a hospital has to 
fill out, a single form that a patient has to fill out, and 
everybody is clearly covered by producing a card, then all those 
people who are busily at work trying to figure out who's not 
covered under what health insurance policy; or why the health 
insurance policy needs to be cut off; or why a small pool can't 
anymore support a person who's got a sick child -- those jobs 
will go down in number dramatically.  But we'll have a big 
increase in jobs in health care providers -- people who work in 
home health, for example.
	     
	     Some small businesses will pay more because they 
don't pay anything now or they have very limited policies now.  
But on average, it will add 1 to 2 percent to their cost of doing 
business, and all their competitors will have to do the same 
thing.  And within a few years they'll all be saving so much more 
because medical inflation will be less.  
	     
	     The Congressional Budget Office is a nonpartisan 
group that did a study on this.  They estimate that on average, 
within five years we'll be creating many more jobs in the small 
business sector because we'll lower medical inflation and all 
small business people will be on equal competitive terms.  
	     
	     So I think there will be some job loss, more job 
gain in the short run in health care, and big job gains over the 
long run by bringing health costs in line with inflation.
	     
	     MR. MEIER:  Thank you, Milwaukee.  Thank you, Mr. 
President.  We want to now go to Sioux Falls, South Dakota.
	     
	     Q    Mr. President, our next participant is not 
looking for work.  He provides jobs.  He is providing also the 
prospective of tonight's program of the small business person in 
small town America.  This gentleman is an auto dealer in Platt, 
South Dakota, a town of about 1,300 people.  Your question for 
the President.
	     
	     Q    Good evening, Mr. President.  Most big 
businesses in corporate America provide health insurance for 
their employees and also millions of retirees with pretax 
dollars.  My concern is the cost this is going to probably have 
on your plan.  If the Clinton plan becomes law, would this 
release of the liability of businesses from providing health 
insurance to retirees, and if so who does pay for it?
	     
	     THE PRESIDENT:  It would relieve them of some of 
their responsibilities for paying for the early retirees.  And 
they would be in the retiree pool in our health care program.  
But I still believe it's good economics, because a lot of these 
companies are paying now 15, 16, 17, 18 percent of their payroll 
as compared with the national average of 8 to 8.5 percent of 
payroll for health care.  And that is undermining their ability 
to reinvest money and to create more jobs and to make our economy 
stronger. 
	     
	     Most of those companies that are severely affected 
by this are companies like automobiles and steel, which had to 
have huge layoffs through early retirement all during the 1980s 
to be competitive.  In other words, it wasn't a decision they 
made, it was necessity.  And they had contracts which required 
them to carry these health burdens.  
	     
	     We believe for relatively modest cost we can 
generate a huge amount of money in these sectors, which are now 
prospering, to create more jobs and help strengthen the American 
economy.  So we think that it'll be about a wash that we can well 
afford. 
	     
	      Let me say, sir, that we have had the cost of our 
plan evaluated by any number of people, including groups that are 
composed largely of folks that were active in the previous two 
Republican administrations.  And all of them say more or less the 
same thing -- that over the 10-year period, our numbers are 
right.  The differ from year to year sometimes, but I think that 
the cost figures in my plan are good because we've bent over 
backwards, we've contacted 10 different medical actuarial firms 
and also had a lot of outsiders look at it.  I think the numbers 
are right.
	     
	     MS. ASTORE:  Thank you, Sioux Falls.  Mr. President, 
we have time for one final question here in the Twin Cities.  And 
we'd like you to pick a member of the audience to ask that final 
question.  (Laughter.)

	     THE PRESIDENT:  Go ahead.
	     
	     MR. MEIER:  Wait, wait, wait, wait.  I've got to 
pull a Donahue here and get up there.  (Laughter.)
	     
	     THE PRESIDENT:  Maybe we'll do two if you can do it 
real quick.
	     
	     MR. MEIER:  Tell us your name and what your question 
is.
	     
	     Q    I'm from Dayton, Minnesota.  And one word I 
haven't heard the whole time I've been listening to the news 
programs about the plan is dental.  And I'm a person whose teeth 
have not been kind to me.  And that's my major medical budget in 
my household for myself is teeth.  And I'm really concerned about 
that.  Is there going to be any thought or any kind of provision 
at all for that type of medical care, because that can affect 
your health.
	     
	     THE PRESIDENT:  Yes -- we're running out of time.  I 
can't give you the whole details.  But the short answer is yes.  
You'll have to pay some of it, and I'll get you the details.
	     
	     Go ahead, what's your question?  Thank you.
	     
	     MS. ASTORE:  Hurry, Randy.
	     
	     THE PRESIDENT:  We can do it.  We can do it.
	     
	     MR. MEIER:  I'm getting there.  Here we go.  Your 
name, and what your question is.
	     
	     Q    Thank you, Mr. President.  I have a handicapped 
daughter.  She grew up with severe handicap.  And as she's 
getting older -- she's out on her own right now -- but she cannot 
get any type of medical help whatsoever from anywhere.  I'd like 
to know what your plan has that will help her to be able to 
succeed in life and do what she wants to do and still have 
coverage.
	     
	     THE PRESIDENT:  What's her handicap?
	     
	     Q    Right now it's a form of scoliosis.  She's got 
a severe curvature; she's had a back spinal fusion amongst other 
things.
	     
	     THE PRESIDENT:  Your daughter would be able to buy 
insurance as an individual once she be becomes an adult on the 
same terms as anybody.  
	     
	     Now, the only way we can do that is if we organize 
the insurance markets and the buyers so that they're big 
insurance pools and large numbers of buyers so we can spread the 
risk of some future illness or problem of hers across a large 
number of people.
	     
	     I do want to make full disclosure, because one of 
the first questions I got was who would pay more under this plan.  
We would ask young single workers to pay a little more per month 
than they would otherwise pay so that we'd be able to insure 
people like your daughter and older workers on affordable terms.  
I think, again, that's a fair thing because young, single workers 
want to be older some day, number one; and they're going to be 
married, they're going to have children, and they might have 
children that have health problems. 
	     
	     So I think it's a fair thing to do.  But that's the 
way it would work.  That's the way, by the way, other countries 
do it.  And your daughter would be able to get insurance.
	     
	     MS. ASTORE:  President Clinton, we're coming to the 
end of our town hall meeting.  We'd like to give you this 
opportunity to offer some closing remarks.
	     
	     THE PRESIDENT:  I just want to make two points after 
I say, thank you to all of you.  Thank you to those of you who 
asked questions and those who couldn't get your questions asked.
	     
	     For those of you in the other sites, if you had a 
question that didn't get answered, send it to us and we'll answer 
it.  And those of you that are here, I'll just gather them up 
while I'm here.  (Laughter.)
	     
	     I want to make two points if I might.  We can differ 
about the details of this, but the one thing that we have to 
decide on as a people is, are we going to continue to be the only 
advanced economy in the entire world that can't figure out how to 
provide health insurance for all of its people so that we insure 
people and pay for them if they are on welfare, but we punish 
working people.  Or are we going to solve this problem after 
talking about it for 60 years now?  
	     
	     The second thing I want to say is this -- to go back 
to a point I made at the beginning.  This is a complicated issue.  
I've tried to shoot straight with you and tell you what the 
problems are with it.  I respect people who have differences of 
opinion with me on exactly how we should do it.
	     
	     But what I want to ask you to do is to try to 
communicate to your members of Congress, without regard to party, 
that Republicans and Independents and Democrats all get sick, all 
have kids, all have parents, all have hopes, all have fears; and 
that it's okay for us to disagree about this in terms of the 
details, but it is not okay to let another year go by and not 
deal with it.
	     
	     And what I ask you to do is not so much to say, Bill 
Clinton's right about everything.  But to say, this is a serious 
problem, we have to deal with it, please act now.  We will not 
know any more about this next year than we do this year.  It's 
just going to be like an ingrown toenail.  It will get worse, not 
better, if we don't move.
	     
	     So that is what I plead with you to do.  Ask your 
members of Congress to act now and to work in the spirit of 
humanity, bipartisanship and common sense and let's get this 
done.
	     
	     Thank you very much.  (Applause.)
	     
	     MR.  MEIER:  Thank you, Mr. President.  I'm sure 
we've all enjoyed this opportunity to meet with you tonight.  
It's a very important issue, and I thank we all learned something 
here tonight.
	     
	     MS. ASTORE:  We hope by getting together tonight, 
we've helped to shed some light on this complicated issue for our 
live audiences and our viewers on the satellites.
	     
	     Thank you for joining us, everyone.  Good night.

			       END8:30 P.M. CDT

